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Flashcards in Liver and Transplant Deck (20):
1

What are three immune complications possible with transplant

Rejection, Infection, Malignancy

2

What do high levels of AST and ALT relate to the function which organ?

Liver

3

What are the different type of organ rejection?

-Hyperacute

-Acute Early (CD8-driven)

-Acute Late (CD-4 driven)

-Chronic

 

4

Describe Hyperacute Rejection

1. Pre-existing Ab's bind onto donor Ag's

2. These Ab's allow for activation of complement

3. Complement leads to inflammation

4. Result is thrombosis

5

List the important characteristics of early vs. late acute rejection

Early Acute

-Days to weeks after transpllant

-Early rejection involves CTLs

-CTLs react to donor APC presenting donor Ag on MHC I

Late Acute

-Months to years after transplant

Th1 mediated CD4+

-T cells responding to recipient ACP presenting donor Ag on MHC II

6

In which organs is hyperacute rejection most common?

Lung, Kidney, Heart

7

With transplant surgery, these is alot of damage. Describe how that damage manifests an immune response

DAMPS (Hsp70, polysaccharide fragments from heparin sulfate, HMBG1/Rage, Fibrinogen) --> PPR (TLRs, CLRs, NODs, BLRs, RLRs) --> Innate immune system --> inflammation, complement, leukocyte recruitment, clearance and killing, and adaptive immunity

8

Differentiate between direct and indirect activation of the host immune system

Direct: The donor APC presents donor Ag on MHC class I to host CD8+ Cells

Indirect: The host APC presents donor Ag on MHC class I to host CD4+ T cells

9

Is it possible for acute rejection to display a mixtube of both CD4+ and CD8+ cellular infiltrate?

Yes, this can make classification difficult

10

If you have a patient who present with both histologically and biochemically acute rejection, what is the first line treatment?

Steroids, the side effects suck though

11

What is chronic rejection exemplified by?

Duct loss and less inflammation, more fibrosis

12

If steroids dont work, then what?

Anti-thymocyte Globulins (bind and sequester, can lead to destruction) - this is basically an anti-T cell drug, it is a polyclonal antibody against numerous lymphocyte markers that will eithe inhibit or destory T-cells

Anti-CD3 (OKT3)

Anti-ILR

13

Which two drugs inhibit activation of calcineurin?

Cyclophosphamide and Tacrolimus

14

What is the mechanism of sirolimus?

Helps block signaling through IL-2R, thus preventing replication that is induced by IL-2, like T-cells

15

What is this?

Recurrent HCV

-actually looks pretty good though, because there is no attack on the bilary ducts

16

What does PTLD stand for? What type of infection is it most commonly associated with?

Post-Transplant Lymphoproliferative Disorder: reactivation or primary infection of EBV

17

PTLD happens why?

Since we use immunosuppressant, the pateients CTLs are not able to do enough immune survellience and so virus has free raign, so do tumors

18

How do you trat PTLD?

1. reduce immunosuppression

2. Ab therapy vs. B cells like Rituximab

3. Chemo

4. Adoptive T cell therapy

5. antibiral agents are relatively limited

19

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20

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